A major clinical trial presented at a leading cardiology conference has found that patients with an irregular heartbeat who also have a heart stent may fare better on a single blood-thinning drug than on two.
The findings come from the ADAPT AF-DES trial, presented at the American Heart Association Scientific Sessions and published by the New England Journal of Medicine. The study looked at patients with atrial fibrillation (AF) — a condition where the heart beats irregularly — who had a coronary stent (a small mesh tube inserted to keep a heart artery open) placed at least a year before the trial began.
Researchers compared two treatment approaches. One group received a NOAC (non–vitamin K antagonist oral anticoagulant) — a type of blood-thinning tablet that reduces stroke risk in AF — on its own. The other group took a NOAC alongside clopidogrel, an antiplatelet drug commonly used after stent procedures to stop blood clots forming around the metal mesh.
The results favoured the simpler approach. Patients on NOAC monotherapy — meaning the single drug alone — experienced fewer net adverse clinical events over 12 months than those on the combination. “Net adverse clinical events” is the measure researchers use to weigh up both harmful blood clots and serious bleeding episodes together.
This matters because the two conditions pull in opposite directions. AF raises the risk of stroke, so patients need anticoagulation. But stents carry their own clotting risk, which has traditionally led doctors to add clopidogrel. The trial’s findings suggest that for patients whose stents are at least a year old, the extra drug may cause more harm — largely through bleeding — than it prevents.
The trial results were presented at the AHA Scientific Sessions, one of the world’s largest interventional cardiology conferences, and reported by the New England Journal of Medicine.
Source: @NEJM